Anesth Pain Med.  2017 Apr;12(2):176-182. 10.17085/apm.2017.12.2.176.

A comparison of continuous femoral nerve block combined with sciatic nerve block and epidural analgesia for postoperative pain management after total knee replacement

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Yeungnam University College of Medicine, Daegu, Korea. apsj0718@naver.com
  • 2Department of Orthopedic Surgery, Yeungnam University College of Medicine, Daegu, Korea.

Abstract

BACKGROUND
Epidural analgesia (EPA) has been used for postoperative pain control in total knee replacement (TKR). However, many patients have suffered various side effects after epidural blockade. Peripheral nerve block (PNB) has been shown to provide effective pain relief after TKR. We compared the benefits of continuous femoral nerve block (FNB) combined with single-injection sciatic nerve block (SNB) with those of EPA for postoperative pain management after TKR.
METHODS
Eighty participants undergoing unilateral TKR were randomized to receive either EPA (EPA group) or continuous FNB combined with SNB (PNB group). All patients received general anesthesia for TKR. Ropivacaine 2 mg/ml plus fentanyl 2 µg/ml was administered for EPA. Ropivacaine 2 mg/ml was administered through the femoral nerve catheter. The pain score, side effects (dizziness, sedation, nausea, vomiting, pruritus, hypotension and urinary retention), motor blockade, knee range of motion, and rehabilitation were measured postoperatively. The primary outcome measure was the number of patients experiencing side effects.
RESULTS
The incidence of patients with side effects was 86.8% in the EPA group but only 35.1% in the PNB group (P < 0.001). There were no significant differences between the two groups in terms of pain score, motor blockade of the operative limb, knee range of motion, or rehabilitation.
CONCLUSIONS
Continuous FNB combined with SNB can be an effective alternative to EPA for postoperative pain management in TKR.

Keyword

Epidural analgesia; Femoral nerve; Knee replacement; Postoperative pain; Sciatic nerve

MeSH Terms

Analgesia, Epidural*
Anesthesia, General
Arthroplasty, Replacement, Knee*
Catheters
Extremities
Femoral Nerve*
Fentanyl
Humans
Hypotension
Incidence
Knee
Nausea
Outcome Assessment (Health Care)
Pain, Postoperative*
Peripheral Nerves
Pruritus
Range of Motion, Articular
Rehabilitation
Sciatic Nerve*
Vomiting
Fentanyl

Reference

1. Zaric D, Boysen K, Christiansen C, Christiansen J, Stephensen S, Christensen B. A comparison of epidural analgesia with combined continuous femoral-sciatic nerve blocks after total knee replacement. Anesth Analg. 2006; 102:1240–6. DOI: 10.1213/01.ane.0000198561.03742.50. PMID: 16551931.
2. Lorenzini C, Moreira LB, Ferreira MB. Efficacy of ropivacaine compared with ropivacaine plus sufentanil for postoperative analgesia after major knee surgery. Anaesthesia. 2002; 57:424–8. DOI: 10.1046/j.0003-2409.2001.02393.x. PMID: 11966550.
3. Davies AF, Segar EP, Murdoch J, Wright DE, Wilson IH. Epidural infusion or combined femoral and sciatic nerve blocks as perioperative analgesia for knee arthroplasty. Br J Anaesth. 2004; 93:368–74. DOI: 10.1093/bja/aeh224. PMID: 15247111.
4. Barrington MJ, Olive D, Low K, Scott DA, Brittain J, Choong P. Continuous femoral nerve blockade or epidural analgesia after total knee replacement:a prospective randomized controlled trial. Anesth Analg. 2005; 101:1824–9. DOI: 10.1213/01.ANE.0000184113.57416.DD. PMID: 16301267.
5. Paul JE, Arya A, Hurlburt L, Cheng J, Thabane L, Tidy A, et al. Femoral nerve block improves analgesia outcomes after total knee arthroplasty:a meta-analysis of randomized controlled trials. Anesthesiology. 2010; 113:1144–62. DOI: 10.1097/ALN.0b013e3181f4b18. PMID: 20966667.
6. Pham Dang C, Gautheron E, Guilley J, Fernandez M, Waast D, Volteau C, et al. The value of adding sciatic block to continuous femoral block for analgesia after total knee replacement. Reg Anesth Pain Med. 2005; 30:128–33. DOI: 10.1097/00115550-200503000-00003. DOI: 10.1016/j.rapm.2004.11.009. PMID: 15765454.
7. Fournier R, Faust A, Chassot O, Gamulin Z. Levobupivacaine 0.5% provides longer analgesia after sciatic nerve block using the Labat approach than the same dose of ropivacaine in foot and ankle surgery. Anesth Analg. 2010; 110:1486–9. DOI: 10.1213/ANE.0b013e3181d3e80b. PMID: 20304982.
8. Wegener JT, van Ooij B, van Dijk CN, Hollmann MW, Preckel B, Stevens MF. Value of single-injection or continuous sciatic nerve block in addition to a continuous femoral nerve block in patients undergoing total knee arthroplasty:a prospective, randomized, controlled trial. Reg Anesth Pain Med. 2011; 36:481–8. DOI: 10.1097/AAP.0b013e318228c33a. PMID: 21857273.
9. Morin AM, Kratz CD, Eberhart LH, Dinges G, Heider E, Schwarz N, et al. Postoperative analgesia and functional recovery after total-knee replacement:comparison of a continuous posterior lumbar plexus (psoas compartment) block, a continuous femoral nerve block, and the combination of a continuous femoral and sciatic nerve block. Reg Anesth Pain Med. 2005; 30:434–45. DOI: 10.1097/00115550-200509000-00004. PMID: 16135347.
10. Chan EY, Fransen M, Sathappan S, Chua NH, Chan YH, Chua N. Comparing the analgesia effects of single-injection and continuous femoral nerve blocks with patient controlled analgesia after total knee arthroplasty. J Arthroplasty. 2013; 28:608–13. DOI: 10.1016/j.arth.2012.06.039. PMID: 23142441.
11. Hadzic A. Hadzic’s peripheral nerve blocks and anatomy for ultrasound-guided regional anesthesia. 2nd ed. New York: McGrawHill;2012. p. 442–5.
12. Butterworth JF, Mackey DC, Wasnick JD. Clincal anesthesilolgy. 5th ed. New York: McGrawHill;2013. p. 966–72.
13. Capdevila X, Barthelet Y, Biboulet P, Ryckwaert Y, Rubenovitch J, d’Athis F. Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery. Anesthesiology. 1999; 91:8–15. DOI: 10.1097/00000542-199907000-00006. PMID: 10422923.
14. Chelly JE, Greger J, Gebhard R, Coupe K, Clyburn TA, Buckle R, et al. Continuous femoral blocks improve recovery and outcome of patients undergoing total knee arthroplasty. J Arthroplasty. 2001; 16:436–45. DOI: 10.1054/arth.2001.23622. PMID: 11402405.
15. Sakai N, Inoue T, Kunugiza Y, Tomita T, Mashimo T. Continuous femoral versus epidural block for attainment of 120°knee flexion after total knee arthroplasty:a randomized controlled trial. J Arthroplasty. 2013; 28:807–14. DOI: 10.1016/j.arth.2012.09.013. PMID: 23434107.
16. Shanthanna H, Huilgol M, Manivackam VK, Maniar A. Comparative study of ultrasound-guided continuous femoral nerve blockade with continuous epidural analgesia for pain relief following total knee replacement. Indian J Anaesth. 2012; 56:270–5. DOI: 10.4103/0019-5049.98776. PMID: 22923827. PMCID: PMC3425288.
17. Sundarathiti P, Ruananukul N, Channum T, Kitkunasathean C, Mantay A, Thammasakulsiri J, et al. A comparison of continuous femoral nerve block (CFNB) and continuous epidural infusion (CEI) in postoperative analgesia and knee rehabilitation after total knee arthroplasty (TKA). J Med Assoc Thai. 2009; 92:328–34. PMID: 19301724.
18. Al-Zahrani T, Doais KS, Aljassir F, Alshaygy I, Albishi W, Terkawi AS. Randomized clinical trial of continuous femoral nerve block combined with sciatic nerve block versus epidural analgesia for unilateral total knee arthroplasty. J Arthroplasty. 2015; 30:149–54. DOI: 10.1016/j.arth.2014.07.032. PMID: 25149364.
19. Sato K, Adachi T, Shirai N, Naoi N. Continuous versus single-injection sciatic nerve block added to continuous femoral nerve block for analgesia after total knee arthroplasty:a prospective, randomized, double-blind study. Reg Anesth Pain Med. 2014; 39:225–9. DOI: 10.1097/AAP.0000000000000076. PMID: 24682080.
20. Weller RS, Butterworth J. Opioids as local anesthetic adjuvants for peripheral nerve block. Tech Reg Anesth Pain Manag. 2004; 8:123–8. DOI: 10.1053/j.trap.2004.03.005.
21. Axelsson K, Gupta A. Local anaesthetic adjuvants:neuraxial versus peripheral nerve block. Curr Opin Anaesthesiol. 2009; 22:649–54. DOI: 10.1097/ACO.0b013e32832ee847. PMID: 19593120.
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